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Going solo: my experience as an independent practitioner


Jane Warner, self-employed nurse, has a few tips for those considering going it alone

A little over one year ago, I set myself up as an independent general practice nurse. To be frank, it isn’t going spectacularly well. However, my experiences should not deter those who wish to consider swapping their monthly pay cheque for freedom and flexibility.

The problem lies entirely with me; in common with the anatomical features of the majority of humanity, I have 206 bones in my body, but unfortunately not one of these could even be remotely described as entrepreneurial. A classic example of this occurred when I purchased my public liability insurance – an absolute prerequisite for anyone venturing to work independently. I turned down the option of the accompanying offer of free online advertising, considering it to be boastful.

Here are a few pointers worth reflecting on. Firstly, why would you even consider quitting your place of work? Most surgeries are warm, happy and congenial, based on teamwork, mutual respect and the genuine desire to focus on what really matters – the patients. If you happen to be employed in such a setting, a) why move at all, and b) do they have any vacancies?

Not everything in the garden is quite as rosy. This is the litany of just some of the key features of what some practice nurses have to put up with, and it’s truly dispiriting. For instance, no Agenda for Change because they can’t afford it, forelock- tugging to be permitted to attend professional updates, workplace bullying, no opportunity for clinical supervision, lack of rigorous appraisal, salary just a few pounds an hour greater than HCA rates, a tick- box culture, and managers who have little appreciation of what nurses do. If this represents your workplace culture, you can, and perhaps should, make the break. Perhaps to another practice, not necessarily into self- employment.

But before you make your move to independence, think very carefully. What sort of person are you? Do you find that you seem to achieve more outside any organisation you work for than within its confines? If so, becoming self-employed could be a good move. Square pegs are not happy being fitted into round holes – and if you don’t believe me, imagine Gaudi assembling a flat pack wardrobe, with Escher handing him the screwdriver.

Assuming you do go ahead, and you’ve contacted local medical centres to let them know what a wonderful person you are (without boasting), here are just a few of the survival tips I have found invaluable.

  1. Contact HM Revenue and Customs to let them know about your change of status. They are very helpful and will send you relevant advice.
  2. Keep records of everything connected with your work so that when you do complete a tax return, neither you nor your computer ends up in a cold sweat. I print everything off in case data back up fails.
  3. Ensure you have both public and medical malpractice liability insurance in addition to your professional indemnity.
  4. Charge a fair rate for your professional services. Remember you effectively have no pension, no annual leave and no sick pay. A warning: in over ten years of employment my days of sickness could have been counted on the fingers of one hand. The first thing I did on becoming self employed was to fall, losing the use of my right hand.
  5. Pay your National Insurance contributions. I do this quarterly.
  6. Set aside regular time to read and reflect on clinical journals and update yourself professionally.
  7. Find a way which both protects anonymity and allows you to follow up your actions, e.g., if you are involved in cervical screening.
  8. When you receive payment, do not break open the champagne, however tempting this might seem. Weeks may go by before your next pay cheque arrives.
  9. Prepare to earn perhaps 30% of your previous salary – but cheer up – you can economise. It’s the only career move which allows you to combine feeling pulses with eating them.

Readers' comments (8)

  • Great article, thank you. I have both a nice warm friendly practice and the forelock tugging to a manager that has no idea what I do!

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  • Great article, but could you write more of them expanding the advice please? What is it you do exactly? What other advice do you have? How do you charge for services? etc.

    I have a couple of great ideas about moving into independent practice, but as you say, I am also one of those without an entrepreneurial bone in my body and have very little clue how to go about it.

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  • Thanks for the picture of Gaudi assembling a flatpack wardrobe!!

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  • I am glad that a UK nurse has at last thrown some light on this as I was coming to the conclusion it was not permitted in the UK.

    In France, Germany and Switzerland it is more common, especially in remote areas, where nurses provide community services in nursing and/or midwifery and some set up group practices.

    It would be nice to see more of this in the UK for nurses who wish to work independently and for the service of the patients and to relieve overstretched services. (Maybe with all the current problems in the NHS it will be a way forward in the future).

    It would be good to hear the experiences of any other independent nurse practitioners.

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  • Anonymous | 3-Jun-2011 4:14 pm I agree. I also think it is a possible way forward for our profession. The problem is it is almost an alien culture to us, there need to be a lot more robust services/help/advice to help us do so.

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  • Yes good to hear it can be done-may I also say you should consider being a limited compeny or are you already-then you can claim the clothes on your back and the journals that you read- you will need an accountant but you should check tha he will only charge you what he saves you-good luck

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  • I worked as an Independant Practice Nurse for 10 years when my children were at school. I was never out of work except when I choose to be, school holidays, half term etc.

    The good points:-

    It enabled me to work when I wanted to, to fit in with family life. Mainly I did cover for holiday, sickness, maternity leave, study leave. Word of mouth from Practice Managers and the local PCT provided the work. I also did some insurance screening and occupational health work for Private Companies. All related to Practice work.

    The bad points:- no sick pay, holiday pay or Pension contributions so make your own arrangements.

    I agree, keep scrupulous records, pay your self employed national insurance, (otherwise you state pension will be affected)

    Mostly Practices were delighted that an experienced Nurse can come into their Practice and just get on with it. Some Practices were frankly dreadful but at least you don't have to go back.

    I am now semi retired, my children are grown up and self sufficent, so I work a regular 12 hours a week in a lovely Practice,which I enjoy. However I don't regret those days of Independance. As long as you keep up your registration and indemnity insurance, it is all perfectly legal.

    Go for it!

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  • Please can you send me the details of the company who deals with your professional indemnity insurance.

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